Publications

Abstract

Vigilance has been central to nursing practice since Florence Nightingale. Often, the nurse's work of surveillance goes unnoticed and the public never recognizes the value of the nurse's work. The 1999 Institute of Medicine report on hospital deaths due to preventable errors has lifted the veil shrouding professional vigilance. But how to measure vigilance remained elusive, until the concept, failure to rescue (FTR), was proposed. FTR has taken a prominent role in health care since its adoption as a patient safety indicator by the Agency for Healthcare Research and Quality (AHRQ) and as a measure for nursing performance in acute care by the National Quality Forum (NQF). However, its applicability to school nursing has been unexplored. This article provides an initial review of the literature and an analysis of anecdotal stories and media accounts that illustrate professional vigilance in school nursing practice.

Abstract

Conducting qualitative interviews with seriously ill individuals about end-of-life issues is challenging for interviewers seeking to understand the problems, processes, and experiences individuals undergo when faced with death and dying. Although all qualitative interviewers face issues of building trust and obtaining answers to their research questions, these issues are exacerbated for interviewers of end-of-life issues due to the challenges of debilitated participants, sensitive subject matter, and heightened emotionalism. The purpose of this article is to offer field-tested techniques to tailor basic interviewing practices for discussions of end-of-life issues with seriously ill individuals. Use of tailored techniques facilitates the comfort of both interviewer and participant and enhances the probability of obtaining complete and accurate data, which in turn can improve the effectiveness of subsequent programs, policies, and clinical practice based on research findings.

Abstract

An 11-week culturally relevant group diabetes self-management training (DSMT), coping skills training (CST), and diabetes care intervention was compared to a 10-week usual diabetes education and diabetes care intervention on physiological and psychosocial outcomes in 109 Black women (aged 48 ± 10 years) with type 2 diabetes in primary care (PC). Strong time effects for hemoglobin A1c improvement were seen in both groups from baseline to 3 months and remained similar at 12 and 24 months (p <. 0001). Systolic blood pressure (p = .01) and low-density lipoprotein cholesterol levels (p = .05) improved in both groups from baseline to 24 months. Baseline quality of life ([QOL]; Medical Outcome Study Short Form-36) was low. Social function, role-emotional, and mental health domains increased initially in both groups then declined slightly, with less decline for the experimental group at 12 months. At 24 months, experimental group scores increased. General health (p = .002), vitality (p = .01), role-physical, and bodily pain (p = .02) domains increased in both groups over time. Perceived provider support for diet (p = .0001) and exercise (p = .0001) increased in both groups over time. Diabetes-related emotional distress decreased in the experimental compared to the control group (group × time, p = .01). Findings suggest that both methods of diabetes education combined with care can improve metabolic control, QOL, and perceptions of provider care. CST may further assist in long-term improvements in health outcomes. Behavioral interventions are needed in addition to routine diabetes care, particularly in PC.

Abstract

Objective: To describe prenatal weight gain and postpartum loss patterns among Hispanic women receiving prenatal care at an urban community health center by language preference. Methods: Data were abstracted from medical records of prenatal patients seen from 2000-2008. Included were self-identified Hispanic women, English- or Spanish-speaking, aged 16-40 years, with weight measured at ≤13 and at >37 weeks gestation. Women with preexisting diabetes, hypertension, gestational diabetes, pre-eclampsia, multiple gestation, or pretermdelivery were excluded. Bivariate (t-test, chi-square) and multivariate regression (linear, polychotomous logistic) statistics were used in the analysis. Results: Of 259 women who met eligibility criteria, 52 (20.1%) were primarily Spanish speakers. Overall, 43.6% exceeded prenatal weight gain recommendations; 30.8% of Spanish speakers vs 46.9% of English speakers (P=.07). Among normal-weight women, Spanish speakers gained below and English speakers gained above that recommended (P=.03). At late postpartum, 22.9% overall returned to their baseline body mass index (BMI ±0.5 kg/m2); Spanish speakers retained 1.21 vs 1.53 kg/m2 among English speakers, which was not statistically significant. Adjusting for baseline BMI, age, and smoking status, language preference was not associated with prenatal weight gain or postpartum weight retention. In adjusted models, being overweight at baseline was predictive of excessive prenatal weight gain (OR 2.12, 95%CI .99, 4.53; P=.05); older age was protective for postpartum weight retention (OR .90; 95% CI .82, .98; P=.02). Conclusions: Adherence to prenatal weight gain guidelines was poor and few women returned to their baseline weight at late postpartum, regardless of language preference.

Abstract

From 2005 to 2008, the Bienvenidos Project trained Puerto Rican patients of New York City and New Jersey Methadone Maintenance Treatment Programs to conduct peer-based community outreach to migrant Puerto Rican drug users to reduce migrants' HIV risk behaviors. Ethnographic research, including focus groups, individual interviews, and observations, was conducted with a subset of the patients trained as peers (n 49; 67 male; mean age 40.3 years) to evaluate the self-perceived effects of the intervention. Results of the ethnographic component of this study are summarized. The role of ethnographic methods in implementing and evaluating this kind of intervention is also discussed.